Risk Factors for Persistence of Lower Respiratory Symptoms Among Community Members Exposed to the 2001 World Trade Center Terrorist Attacks

Details

• Personal Author:
  Alper H ; Berger KI ; Cone, James E. ; Farfel MR ; Friedman SM ; Goldring RM ; Jordan HT ; Maslow CB ; Miller Archie SA ; Ortega F ; Reibman J ; Shao Y
• Description:
  Objectives: We studied the course of lower respiratory symptoms (LRS; cough, wheeze or dyspnoea) among community members exposed to the 9/11/2001 World Trade Center (WTC) attacks during a period of 12-13 years following the attacks, and evaluated risk factors for LRS persistence, including peripheral airway dysfunction and post-traumatic stress disorder (PTSD). Methods: Non-smoking adult participants in a case-control study of post-9/11-onset LRS (exam 1, 2008-2010) were recruited for follow-up (exam 2, 2013-2014). Peripheral airway function was assessed with impulse oscillometry measures of R5 and R5-20. Probable PTSD was a PTSD checklist score <44 on a 2006-2007 questionnaire. Results: Of 785 exam 1 participants, 545 (69%) completed exam 2. Most (321, 59%) were asymptomatic at all assessments. Among 192 participants with initial LRS, symptoms resolved for 110 (57%) by exam 2, 55 (29%) had persistent LRS and 27 (14%) had other patterns. The proportion with normal spirometry increased from 65% at exam 1 to 85% at exam 2 in the persistent LRS group (p<0.01) and was stable among asymptomatic participants and those with resolved LRS. By exam 2, spirometry results did not differ across symptom groups; however, R5 and R5-20 abnormalities were more common among participants with persistent LRS (56% and 46%, respectively) than among participants with resolved LRS (30%, p<0.01; 27%, p=0.03) or asymptomatic participants (20%, p<0.001; 8.2%, p<0.001). PTSD, R5 at exam 1, and R5-20 at exam 1 were each independently associated with persistent LRS. Conclusions: Peripheral airway dysfunction and PTSD may contribute to LRS persistence. Assessment of peripheral airway function detected pulmonary damage not evident on spirometry. Mental and physical healthcare for survivors of complex environmental disasters should be coordinated carefully. [Description provided by NIOSH]
• Subjects:
  Air Pollutants, Occupational Dust Environmental Exposure Lung Lung Diseases Mental Health Nervous System Occupational Health Particulate Matter Respiratory Function Tests Respiratory System Respiratory Tract Diseases Risk Assessment Risk Factors Safety September 11 Terrorist Attacks Surveys And Questionnaires

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• Keywords:
  Case Control Studies Dust Exposure Dust Particles Dusts Exposure Levels Fumes Health Care Mental Health Physical Reactions Physiology Post-traumatic Stress Disorder PTSD Pulmonary Disorders Pulmonary System Pulmonary System Disorders Questionnaires Respiratory Function Respiratory Irritants Respiratory System Disorders Risk Factors Spirometry Statistical Analysis Terrorism World Trade Center WTC

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• ISSN:
  1351-0711
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Journal Article
• Place as Subject:
  New York ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  449-445
• Volume:
  74
• Issue:
  6
• NIOSHTIC Number:
  nn:20049546
• Citation:
  Occup Environ Med 2017 Jun; 74(6):449-455
• Contact Point Address:
  Dr Hannah T Jordan, Deputy Medical Director, World Trade Center Health Registry; New York City Department of Health and Mental Hygiene; 125 Worth Street, 10th floor, CN 6W, New York, NY 10013, USA
• Email:
  hjordan1@health.nyc.gov
• Federal Fiscal Year:
  2017
• Performing Organization:
  New York City Health/Mental Hygiene
• Peer Reviewed:
  True
• Start Date:
  20090430
• Source Full Name:
  Occupational and Environmental Medicine
• End Date:
  20260630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:b1391c111b73feb384e94f39925c5c03c49a9299cc6e12d1ec6d29dbcc6fcebeab8acbaa3206cab3d5f91832220ed246ec85948edaee1a6736a25d763b62dc26
• Download URL:
  https://stacks.cdc.gov/view/cdc/210290/cdc_210290_DS1.pdf
• File Type:
  [PDF - 693.57 KB ]